İdyopatik membranöz glomerulonefrit tanılı erişkin hastaların tedavi sonuçlarının retrospektif analizi
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Date
2017
Authors
Şanlı, Cemile
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bir immun kompleks nefropatisi olan membranöz glomerulonefrit (MGN) nefrotik sendromun en sık sebeplerinden biridir. Spontan remisyon görülebilmek ile birlikte, uzun dönemde son dönem böbrek yetmezliği gelişebilir. MGN tedavisinde tam bir görüş birliği olmasa da bazı risk gruplarında immünsüpresif tedavi yaklaşımları önceliklidir. Biz de çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Hastanesi kayıtlarındaki mevcut veriler ile MGN tanılı hastaların epidemiyolojik bulgularını, laboratuvar verilerini, tedavi cevaplarını ve tedaviye cevap üzerine etkili olabilecek faktörleri incelemeyi amaçladık. Çalışmaya Nefroloji bölümüne MGN tanısı ile Mart 2007-Kasım 2015 tarihleri arasında başvuran 99 hasta dahil edildi. Takip süresi 3 aydan kısa olanlar, tedaviyi kabul etmeyenler ve MGN'ye sebep olabilecek sekonder nedeni olanlar çalışmaya alınmadı. Hastaların demografik özelliklerinin yanı sıra klinik ve laboratuvar bulguları elektronik ortamda hastane bilgi yönetim sistemi ile retrospektif olarak incelendi. 99 hastanın 43'ü (%43,4) kadın, 56'sı (%56,6) erkek idi. Tüm hastaların yaş ortalaması 46,7, ortalama izlem süresi 18,5 ay idi. Tanı anında hematürisi olan hasta oranı %63,6, ödem saptanan hasta oranı %76,8, hipertansiyon saptanma oranı %35,3 idi. Vakaların %31,3'ünde farklı evrelerde renal disfonksiyon mevcuttu. Nefrotik düzeyde proteinüri ile başvuran hasta sayısı 71 (%71,7), nefrotik sendrom ile başvuran hasta sayısı ise 57 (%57,6) idi. Tedavide immunsupresif ilaçları hastaların 85'ine (%85,9) verildi. Immunsupresif tedavi verilen hastaların 57'sinde (%79,9) tanı anında ağır seviyede proteinüri vardı. İmmunsupresif tedavi alan hastaların 63'ünde (%74,1) remisyon sağlandı, konservatif tedavi ile takip edilen hastaların ise 10'unda (%71,3) remisyon görüldü. Çalışmamızda hastaların yaş ve cinsiyet dağılımı, nefrotik düzeydeki proteinüri oranı, nefrotik sendromla başvuru oranı ve immunsupresifle tedaviye cevap oranı literatür ile benzerdi. Başlangıçta hipertansiyon varlığının ve bazal membranda IgG birikiminin tedavi yanıtını azalttığı saptandı.
Membranous glomerulonephritis (MGN), an immunocompetent nephropathy, is one of the most common causes of nephrotic syndrome. Although spontaneous remission can be seen, long-term end-stage renal failure may develop. Although there is no full consensus on MGN treatment, immunosuppressive treatment approaches are of paramount importance in some risk groups. In our study, we aimed to investigate the epidemiological findings, laboratory data, treatment responses and the factors that might be effective on the response to treatment in patients with MGN and the current data in Uludağ University Medical Faculty Hospital. In the Nephrology section of the study, 99 patients with MGN diagnosis between March 2007 and November 2015 were included. Those who were short of 3 months of follow-up, those who did not accept the treatment, and those who had a secondary cause that could cause MGN were not taken to work. Clinical and laboratory findings as well as demographic characteristics of the patients were examined retrospectively with electronic hospital information management system. Of the 99 patients, 43 (43.4%) were female and 56 (56.6%) were male. The mean age of all patients was 46.7 and the mean follow-up was 18.5 months. The rate of patients with hematuria at the time of diagnosis was 63.6%, the rate of edema was 76.8% and the rate of hypertension was 35.3%. 31.3% of the cases had renal dysfunction at different stages. The number of patients with nephrotic proteinuria was 71 (71.7%) and the number of patients with nephrotic syndrome was 57 (57.6%). Immunosuppressive drugs were given in 85 (85.9%) of the patients. 57 (79.9%) of the patients treated with immunosuppressive therapy had proteinuria at the level of diagnosis at the time of diagnosis. Remission was achieved in 63 (74.1%) of the patients receiving immunosuppressive therapy and remission in 10 (71.3%) of the patients followed by conservative treatment. In our study, age and gender distribution of patients, proteinuria rate at nephrotic level, application rate with nephrotic syndrome and response rate with immunosuppressive treatment were similar to the literature. Initially, the presence of hypertension and accumulation of basal membrane IgG decreased the response to treatment.
Membranous glomerulonephritis (MGN), an immunocompetent nephropathy, is one of the most common causes of nephrotic syndrome. Although spontaneous remission can be seen, long-term end-stage renal failure may develop. Although there is no full consensus on MGN treatment, immunosuppressive treatment approaches are of paramount importance in some risk groups. In our study, we aimed to investigate the epidemiological findings, laboratory data, treatment responses and the factors that might be effective on the response to treatment in patients with MGN and the current data in Uludağ University Medical Faculty Hospital. In the Nephrology section of the study, 99 patients with MGN diagnosis between March 2007 and November 2015 were included. Those who were short of 3 months of follow-up, those who did not accept the treatment, and those who had a secondary cause that could cause MGN were not taken to work. Clinical and laboratory findings as well as demographic characteristics of the patients were examined retrospectively with electronic hospital information management system. Of the 99 patients, 43 (43.4%) were female and 56 (56.6%) were male. The mean age of all patients was 46.7 and the mean follow-up was 18.5 months. The rate of patients with hematuria at the time of diagnosis was 63.6%, the rate of edema was 76.8% and the rate of hypertension was 35.3%. 31.3% of the cases had renal dysfunction at different stages. The number of patients with nephrotic proteinuria was 71 (71.7%) and the number of patients with nephrotic syndrome was 57 (57.6%). Immunosuppressive drugs were given in 85 (85.9%) of the patients. 57 (79.9%) of the patients treated with immunosuppressive therapy had proteinuria at the level of diagnosis at the time of diagnosis. Remission was achieved in 63 (74.1%) of the patients receiving immunosuppressive therapy and remission in 10 (71.3%) of the patients followed by conservative treatment. In our study, age and gender distribution of patients, proteinuria rate at nephrotic level, application rate with nephrotic syndrome and response rate with immunosuppressive treatment were similar to the literature. Initially, the presence of hypertension and accumulation of basal membrane IgG decreased the response to treatment.
Description
Keywords
Membranöz glomerulonefrit, Immunsupresif tedavi, Remisyon, Membranous glomerulonephritis, Immunosuppressive therapy, Remission
Citation
Şanlı, C. (2017). İdyopatik membranöz glomerulonefrit tanılı erişkin hastaların tedavi sonuçlarının retrospektif analizi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.